Hybrid Manager, Provider Network Optimization

at Centene Corporation

• Job title: Manager, Provider Network Optimization
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $87,700 - $157,800 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, United States

About the role

• Lead Provider Network Optimization at Centene, overseeing hospital and physician contracting activities. Ensure compliance with healthcare guidelines and manage provider relationships.

Responsibilities

• Lead, negotiate, and manage multiple hospital, large medical group, physician, school and/or ancillary contracting activities in accordance with Corporate, health plan, and state guidelines
• Oversee all activities of the contracting department
• Develop and implement a network development plan for an assigned region and set of providers and identify and initiate contact with potential providers
• Negotiate contracts with interested providers utilizing model provider agreements, and follow up on contracts
• Lead negotiations, rate modeling, implementation and ongoing monitoring of assigned group of providers to maximize business relationships and opportunities
• Oversee provider set-up and contract configuration to ensure accurate claims adjudication and facilitate the organization of provider focus groups
• Evaluate and monitor providers’ performance standards and financial performance of contracts
• Ensures compliance with national contracting standards, reimbursement standards, provider set-up rules, exception process and use of model contract language
• Perform financial analyses to identify medical cost improvement opportunities and develop and execute contracting action plans to achieve results
• Performs other duties as assigned
• Complies with all policies and standards

Requirements

• Bachelor’s degree in Healthcare Administration, Business Administration, Marketing, related field or equivalent experience
• 4+ years of provider relations/contracting experience in a healthcare and/or managed care environment
• Working knowledge of contracting language and the principles of negotiation
• Familiarity with managed care, State and/or Federal health care programs
• Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff
• Valid driver's license
• Candidates must be in the state of Michigan to be considered for this role.

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules